What do you carry in on a call?

[EMS5]

Just out of curiosity to see how different people in different regions do things...

What do you carry in on any given call? Do you go full tilt with the stretcher, board, and every bag on the bus or keep it to a bare minimum or somewhere in the middle?

ALS chase medics and engine company medics feel free to chip in too...

My preference:
We have a "crash" bag which is pretty much ACLS+trauma+bls medical+airway... weighs 40+ pounds and i HATE taking it out...
i carry my stethoscope, notepad, penlight, and our small trauma bag which has a bp cuff in it...if its medical, i'll take our O2 bag in (just a tank and nrb/nc's)...i don't usually unload the stretcher until I need it

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[pianoman511]

I kind of go with my gut and the dispatch info. If it's a doctor's office or long term care facility/nursing home then usually the stretcher, oxygen, and our version of a first in bag that's a hybrid like your "crash" bag +/- monitor depending on chief complaint.

I try not to bring the backboard to a call unless there is specific dispatch data about a patient (i.e. fall with neck pain, head injury, MVA, etc) just because it's a real pain to wheel a stretcher, carry the bag, carry the backboard and carry the headblocks.

If I pull up to the scene and the patient is either walking to the ambulance to meet me or is sitting on their front step then all I bring is me, myself and I. The same goes for any call where the chief complaint is completely ridiculous or a psychiatric patient.

Unfortunately I have been burned before because as we all know dispatch data is not 100%, but for the most part I usually have what I need on a call. Sometimes you just can't help but bring the minimum to a patient with knee pain and end up with a cardiac arrest .

 

[Dwindlin]

Not a thing. That's what Engine Crews are for.

 

[pseudoknot]

If I'm on the ambulance, it really depends on the call. If it's less serious and I'm going to let my crew screw around inside getting vitals and whatever, then we bring more stuff in. If it's more serious, I tend to not want a lot of equipment brought in since we're just going to bring the patient right out. And of course, if it's an active seizure, respiratory or cardiac arrest, then we bring everything.

Yeah, dispatch information isn't always right, but usually you can get some idea of what you're going into.

 

[AegriSomnia]

Where I worked we always brought in our first in bag, O2, and monitor no matter what. Pretty much standard across the region I worked in. Everything else was on a case by case basis. The stretcher and back board or whatever else could be brought in by the engine company as we were initiating care.

 

[joeDO2]

basically everything needed for resuscitation / workup should be brought in on every call. the idea being that ALS care (or BLS for that matter) should be available at the patient side. IMO this is the standard of care and should be mandatory in any EMS system.

with that in mind....

BLS Any Call: First in bag, oxygen equipment, AED

ALS Any Call: First in bag including IV/meds/airway, oxygen, cardiac monitor

Arrest by dispatch info: Autopulse/lucas etc., hypothermia equipment

As needed based on call type/location: c-spine, stair chair, stretcher

 

[pseudoknot]

basically everything needed for resuscitation / workup should be brought in on every call.

Everything? So, everything in the ambulance, right? Presumably anything on the unit might be needed for patient care and that's why we carry it. So you would bring all of it in your bags? Like, OB kit and drug box for an ankle sprain call?

Remember, you can bring the patient to the ambulance too.

IMO this is the standard of care and should be mandatory in any EMS system.

Be careful about throwing that term around. It's a legal term, not a medical one, and it doesn't mean "this is what I think should happen." It means what a jury would find that the average provider in your community at your level of training would do. There are no national standards of care. And given that most EMS providers in places I've been do not carry EVERYTHING to every call, this is most certainly not the standard of care.

 

[joeDO2]

Everything? So, everything in the ambulance, right? Presumably anything on the unit might be needed for patient care and that's why we carry it. So you would bring all of it in your bags? Like, OB kit and drug box for an ankle sprain call?

Remember, you can bring the patient to the ambulance too.



Be careful about throwing that term around. It's a legal term, not a medical one, and it doesn't mean "this is what I think should happen." It means what a jury would find that the average provider in your community at your level of training would do. There are no national standards of care. And given that most EMS providers in places I've been do not carry EVERYTHING to every call, this is most certainly not the standard of care.

agreed that the OB kit can probably stay behind since its not part of your typical resuscitation / als workup equipment. drug box however? you bet. anyone in ems has had those calls that go from ankle sprain to something much more critical. it only takes a little more effort to have your equipment with you. aside from that...not a far leap to go from ankle sprain to ankle fracture...it would be nice to have your IV/narcotics with you rather than have the patient wait until they get to the ambulance for extrication or to make a run back to the truck while they sit in pain.

as for the "standard of care".... in the area i practiced this was the case as it was written into our statewide treatment protocols as well as company policies that crews bring all equipment (1st in bag, airway bag, and monitor) to patient side. I do realize this is not the case in all areas of the country...just my opinion that it should be.

 

[fiznat]

Remember, you can bring the patient to the ambulance too.

Agreed. I always brought our "ALS Bag" which had basic stuff like bandages/BP cuff as well as IV/drug/intubation kits, but only because it was all together. Oftentimes I would leave the monitor in the truck unless I thought it was specifically necessary per dispatch (code, SOB, CP, etc). I might sway towards one extreme or another depending how far the patient was away from where we could park the ambulance (far away = bring more stuff because it would be a PITA to go back and get it).

I never agreed with the "bring everything or else" philosophy. I'm not interested in getting hurt because I'm trying to manage 50 more pounds of unnecessary gear on a carrydown, never mind the extra risk to the patient. What is the standard that says you don't have to bring an OB kit every time but you do need to bring Procanimide? It's a slippery slope. Why not the stair chair on every call? Extra D tanks, surgical airway kit, etc, etc, etc. There is a fine line between prudence and knee-jerk over preparedness. I tried to walk that line the best I could, and was very grateful for a medical control system that allowed me that latitude.

 

[EMS5]

think about how many first line medications you will need to administer before a crew arrives to back you up...1:1 epi, aspirin, nitro, D50, narcan, and adenosine (if you're really on the ball on the diagnosis)
you need airway and good compressions before you worry about arrest meds...most other meds aren't make-or-break like the few i listed above...we carry these plus 1:10, atropine, and lido in our big first in bag...

So basically on most any medical call it eliminates the need for us to have to carry more than a bag and a monitor in, and gives us time to get the pt to the bus before we need to break into the drug bag...also (just for redundancy) they keep first line meds in our airway bag

 

[Lawsonc]

agreed that the OB kit can probably stay behind since its not part of your typical resuscitation / als workup equipment. drug box however? you bet. anyone in ems has had those calls that go from ankle sprain to something much more critical. it only takes a little more effort to have your equipment with you. aside from that...not a far leap to go from ankle sprain to ankle fracture...it would be nice to have your IV/narcotics with you rather than have the patient wait until they get to the ambulance for extrication or to make a run back to the truck while they sit in pain.

as for the "standard of care".... in the area i practiced this was the case as it was written into our statewide treatment protocols as well as company policies that crews bring all equipment (1st in bag, airway bag, and monitor) to patient side. I do realize this is not the case in all areas of the country...just my opinion that it should be.

I pity you, working in a system where you are told what to bring in.

If that is how the call "starts" off, what are those treatment protocols like? Where is the ability to critically think?

First thing in on every call would allow me to take care of the ABCs, because that is all that really matters in those first few minutes of contact. BLS airway adjuncts, and basic trauma dressings with an O2 cylinder, that was the first in bag.